Effectiveness and cost-effectiveness of face-to-face and electronic brief interventions versus screening alone to reduce alcohol consumption among high-risk adolescents presenting to emergency departments: three-arm pragmatic randomized trial (SIPS Junior high risk trial).
Adolescent
alcohol
alcohol screening
brief intervention
cost-effectiveness
effectiveness
electronic brief intervention
emergency department
high risk
pragmatic randomized trial
Journal
Addiction (Abingdon, England)
ISSN: 1360-0443
Titre abrégé: Addiction
Pays: England
ID NLM: 9304118
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
received:
12
04
2021
accepted:
04
03
2022
pubmed:
23
3
2022
medline:
7
7
2022
entrez:
22
3
2022
Statut:
ppublish
Résumé
Alcohol use increases throughout adolescence. Emergency department (ED) attendance is an opportunity for alcohol screening and brief intervention (ASBI), which is effective for adults. This trial evaluated the effectiveness and cost-effectiveness of ASBI compared with screening alone (SA) in high-risk adolescents. Multi-centre, three-group, single-blind, individually randomized trial with follow-ups after 6 and 12 months in 10 ED settings in England. From October 2014 to May 2015 we screened 3327 adolescents aged 14 to 18 years, of whom 756 (22.7%) scored at least 3 on the Alcohol Use Disorders Identification Test: consumption (AUDIT-C) and consented to participate in this trial. Mean age was 16.1 years; 50.2% were female and 84.9% were white. Interventions were personalized feedback and brief advice (PFBA), personalized feedback plus electronic brief intervention (eBI) and SA. The primary outcome was the weekly alcohol consumed in standard UK units (8 g ethanol) at 12 months post-randomization, derived from extended AUDIT-C. Economic outcomes included quality of life and service use, from perspectives of both the National Health Service and personal social services (NHS&PSS) and society. At 12 months, mean weekly consumption was 2.99 [95% confidence interval (CI) = 2.38-3.70] standard units for the SA group, 3.56 (95% CI = 2.90, 4.32) for PFBA and 3.18 (95% CI = 2.50, 3.97) for eBI, showing no significant differences. The PFBA group consumed mean 0.57 (-0.36, 1.70) units more than SA; and eBIs consumed 0.19 (-0.71, 1.30) more. Bayes factors suggested lack of effectiveness explained non-significance. From the NHS&PSS perspective, economic analysis showed that PFBA and eBI were not cost-effective compared with SA: PFBA yielded incremental cost-effectiveness ratio of £6213 (-£736 843, £812 884), with the intervention having 54% probability of being cost-effective compared with SA at the £20 000 WTP threshold. In emergency departments in England, neither personalized feedback and brief advice nor personalized feedback plus electronic brief intervention showed evidence of being effective or cost-effective when compared with screening alone in reducing alcohol consumption among adolescents.
Sections du résumé
BACKGROUND AND AIMS
Alcohol use increases throughout adolescence. Emergency department (ED) attendance is an opportunity for alcohol screening and brief intervention (ASBI), which is effective for adults. This trial evaluated the effectiveness and cost-effectiveness of ASBI compared with screening alone (SA) in high-risk adolescents.
DESIGN, SETTING AND PARTICIPANTS
Multi-centre, three-group, single-blind, individually randomized trial with follow-ups after 6 and 12 months in 10 ED settings in England. From October 2014 to May 2015 we screened 3327 adolescents aged 14 to 18 years, of whom 756 (22.7%) scored at least 3 on the Alcohol Use Disorders Identification Test: consumption (AUDIT-C) and consented to participate in this trial. Mean age was 16.1 years; 50.2% were female and 84.9% were white.
INTERVENTIONS
Interventions were personalized feedback and brief advice (PFBA), personalized feedback plus electronic brief intervention (eBI) and SA.
MEASURES
The primary outcome was the weekly alcohol consumed in standard UK units (8 g ethanol) at 12 months post-randomization, derived from extended AUDIT-C. Economic outcomes included quality of life and service use, from perspectives of both the National Health Service and personal social services (NHS&PSS) and society.
FINDINGS
At 12 months, mean weekly consumption was 2.99 [95% confidence interval (CI) = 2.38-3.70] standard units for the SA group, 3.56 (95% CI = 2.90, 4.32) for PFBA and 3.18 (95% CI = 2.50, 3.97) for eBI, showing no significant differences. The PFBA group consumed mean 0.57 (-0.36, 1.70) units more than SA; and eBIs consumed 0.19 (-0.71, 1.30) more. Bayes factors suggested lack of effectiveness explained non-significance. From the NHS&PSS perspective, economic analysis showed that PFBA and eBI were not cost-effective compared with SA: PFBA yielded incremental cost-effectiveness ratio of £6213 (-£736 843, £812 884), with the intervention having 54% probability of being cost-effective compared with SA at the £20 000 WTP threshold.
CONCLUSIONS
In emergency departments in England, neither personalized feedback and brief advice nor personalized feedback plus electronic brief intervention showed evidence of being effective or cost-effective when compared with screening alone in reducing alcohol consumption among adolescents.
Identifiants
pubmed: 35315170
doi: 10.1111/add.15884
pmc: PMC9540754
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2200-2214Subventions
Organisme : Medical Research Council
ID : G0701681
Pays : United Kingdom
Organisme : Medical Research Council
ID : G0701818
Pays : United Kingdom
Organisme : Department of Health
Pays : United Kingdom
Informations de copyright
© 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.
Références
Drug Alcohol Depend. 2006 Jan 4;81(1):47-54
pubmed: 16006055
J Consult Clin Psychol. 1999 Dec;67(6):989-94
pubmed: 10596521
Addiction. 2022 Aug;117(8):2200-2214
pubmed: 35315170
Health Technol Assess. 2013 Jun;17(25):1-158
pubmed: 23796191
Acta Obstet Gynecol Scand. 2017 Jan;96(1):53-60
pubmed: 27792241
BMC Med Res Methodol. 2013 Dec 06;13:150
pubmed: 24314204
Sci Rep. 2018 Mar 12;8(1):4384
pubmed: 29531280
PLoS One. 2014 Jun 25;9(6):e99463
pubmed: 24963731
Alcohol Clin Exp Res. 1998 Nov;22(8):1842-9
pubmed: 9835306
Addiction. 2015 Oct;110(10):1563-73
pubmed: 26052751
Acad Emerg Med. 2002 Jun;9(6):627-38
pubmed: 12045080
J Med Ethics. 2007 Nov;33(11):659-62
pubmed: 17971470
J Public Health (Oxf). 2019 Mar 1;41(1):e53-e60
pubmed: 29590416
BMC Public Health. 2015 Apr 10;15:345
pubmed: 25886178
Digit Health. 2018 Feb 01;4:2055207617743354
pubmed: 29942622
Addiction. 2022 Mar;117(3):580-589
pubmed: 34374144
Cochrane Database Syst Rev. 2018 Feb 24;2:CD004148
pubmed: 29476653
PLoS Med. 2011 Feb 08;8(2):e1000413
pubmed: 21346802
Addiction. 2008 Feb;103(2):241-8
pubmed: 18199302
Addiction. 2002 Mar;97(3):279-92
pubmed: 11964101
Br J Clin Psychol. 2004 Nov;43(Pt 4):437-48
pubmed: 15530213
J Pediatr. 2004 Sep;145(3):396-402
pubmed: 15343198
Lancet. 2004 Oct 9-15;364(9442):1334-9
pubmed: 15474136
Addiction. 2021 Feb;116(2):412-425
pubmed: 33067856
Int J Drug Policy. 2021 Jul;93:103113
pubmed: 33487528
BMJ. 2011 Feb 07;342:d40
pubmed: 21300711
J Adolesc Health. 2017 Apr;60(4):438-446
pubmed: 28110867
Alcohol Alcohol. 2017 Nov 01;52(6):671-676
pubmed: 29016711
Ann Emerg Med. 2005 Apr;45(4):420-9
pubmed: 15795723
J Med Internet Res. 2014 Jun 02;16(6):e142
pubmed: 24892426
J Med Internet Res. 2013 Jul 16;15(7):e146
pubmed: 23859884